Pain and the Elderly

If you're a senior with a chronic condition such as arthritis, most days start with an ache. Your joints hurt as you crawl out of bed. Each movement sends a shooting pain through your back and/or hip. Even a relaxing walk is out of the question, because your feet are too sore.

You may, in fact, feel like Marilyn Prater, 73, who was unable to return to work as an office manager in her 60's after an operation on her neck did damage to her nerve endings. The surgery left the San Jose, California, resident with pain in the left side of her body that would travel from her foot to her hip. Although the regimen of painkillers dulls its sharp edges, on some days, the pain tears through her.

"I can't lie on my left side at all. I can't even stand sometimes. It's like I'm walking on hot coals," Prater says.

At least 50 million people are wracked with pain that lasts months and even years, according to the American Pain Society. Although experts contend chronic pain is not a normal part of aging, people over 60 are twice as likely to suffer from chronic pain than the rest of the population. To dull the ache, some take drugs such as aspirin or ibuprofen almost every day for relief.

"Pain is the most common complaint in physicians' offices among older patients," says Dr. Bruce Ferrell, associate professor of geriatric medicine and director of the Geriatric Medicine Fellowship Training Program at the University of California, Los Angeles.

Chronic pain may keep you from doing the most basic household chores. You may not walk or exercise because it hurts. Housekeeping and gardening chores feel agonizing. The inactivity makes you weaker, putting you at greater risk for ailments, such as bone loss or fractures. It can disrupt your sleep. Pain can also interfere with your social life, causing you to withdraw from activities with friends and relatives. Ultimately, pain can squeeze everything but itself out of your life. Small wonder that so many pain sufferers become deeply depressed.

"There's not a one of us that hasn't thought of suicide. They think, 'Why go on if you always have this pain? I'm not a contributing person to this family and this community,'" Prater says.

One elderly woman was so embarrassed by the pain she felt when raising objects, she wouldn't attend social events because she couldn't lift a glass or eat normally, says Penny Cowan, founder and executive director of the American Chronic Pain Association, which organizes support groups across the country. "She was concerned about not being able to hold onto things. She didn't want to have to eat in public," Cowan says.

Catching pain early

The good news is that this suffering is largely preventable. Unfortunately, experts say, older people don't think their pain can be relieved and fail to seek treatment -- partly because they believe pain to be a natural part of aging. A Gallup survey for the Arthritis Foundation found 89 percent of adults feel pain at least once a month, but about 66 percent see a doctor only when the ache becomes unbearable. Another drawback is that some doctors are unwilling to prescribe too much pain medication because they fear a patient will become addicted -- even though most patients rate opiates as the most effective treatment.

Bearing up in silence is risky, experts warn, because persistent pain may leave a "memory" in the spinal cord that sets up an ongoing cascade of suffering, like a switch that can't be shut off. That's why eliminating pain in its early stages is so important.

To start with, make an appointment with your family physician or internist. Bring along a list of painkillers and other medications you take, including prescription and over-the-counter drugs, vitamins, nutritional supplements and herbal remedies. This will help him or her design a safe and effective treatment for you.

Unfortunately, some primary physicians undertreat pain, either because they don't understand the devastating impact it can have on lives over time, or they are afraid of scrutiny by licensing boards over narcotic prescriptions. So if your pain persists and interferes with your daily life, or if you're taking medications that over time lead to dependency, then get a second opinion or go to see a pain specialist. You deserve to be as pain-free as possible.

Finding alternative treatments

Perhaps the most effective way to control pain is to combine painkillers with biofeedback or another alternative treatment, doctors and pain experts say. Most programs these days combine pain-killing medication with some type of stress-reduction activity that help you relax and focus your thoughts on something other than what aches. Biofeedback, meditation, massage, counseling, visual imagery, self-hypnosis and acupuncture can also help distract you from the pain itself. Support groups such as the American Chronic Pain Association help teach seniors alternative techniques, such as moderate stretching and meditation.

Stretching and other moderate exercise that restores blood flow can also help control pain. Seniors should consult a doctor before attempting to work out, but some can start with easy exercises, such as leg lifts, Cowan says.

The pain may never go away completely, but you can get the training to help yourself when drugs don't work. Writer Reynolds Price, saddled with searing pain after spinal cancer, found release in a combination of drugs, biofeedback, and hypnosis offered at Duke University's pain treatment center in North Carolina. "I felt an immediate and almost scary kind of physical relief," he says of his first session with hypnosis. "I instantly knew I was free in a way that I'd never felt before in my life, surely not for a moment in the past three years."

For her part, Prater takes a combination of painkillers and antidepressants to ward away aches, and she uses relaxation techniques to distract herself when it becomes unbearable.

"I just put myself on a beach in Tahiti," says Prater, who now runs a support group to help others. "I will never be without pain. I know that I certainly have restrictions. But I can get the pain down to a manageable level. To me that's the goal."

Further Resources

American Academy of Pain Management http://www.aapainmanage.org
Offers a list of accredited pain management centers and other resources.
139747 Mono Way, #A
Sonora, CA 95370
209-533-9744

American Academy of Pain Medicine http://www.painmed.org
Publications include "A Patient's Guide to Pain Medicine."
4700 Lake Ave.
Glenview, IL 60025
847-375-4731

American Chronic Pain Association http://www.theacpa.org
Penny Cowan, executive director
Nonprofit group with 450 chapters nationwide. Offers consumer health information, links, and a list of accredited pain-treatment facilities.
P.O. Box 850
Rocklin, CA 95677
916-632-0922

American Pain Foundation http://www.painfoundation.org
Lists pain-management facilities, publications, and other resources for patients with pain.

American Pain Society http://www.ampainsoc.org
4700 W. Lake Ave.
Glenview, IL 60025
847-375-4715

National Chronic Pain Outreach Association
Offers a quarterly newsletter, publications, and tapes on chronic pain.
7979 Old Georgetown Road, Suite 100
Bethesda, MD 20814-2429
301-652-4948

References

Dobscha, Steven, et al. Journal of the American Medical Association, Marh 24, 2009

American Chronic Pain Association. "Managing Chronic Pain." http://www.theacpa.org/pf_02_04.asp.

American Pain Foundation. "Fifth Vital Sign." Scott M. Fishman, M.D. http://www.painfoundation.org/page.asp?file=QandA/FifthVitalSign.htm&menu=1

American Pain Society. "Pain: Current Understanding of Assessment, Management and Treatments." http://www.ampainsoc.org/ce/npc/

Portenoy, RK. Pain management in the older cancer patient. Oncology, 1992:6(suppl.), pp 86-98.

Ferrell, BA, et al. Pain in the nursing home. Journal of the American Geriatrics Society, 38, pp. 409-414, 1990.

UCLA Healthcare. Personnel. http://www.healthcare.ucla.edu/institution/physician?personnel_id=9837

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